Geriatric Update June 24, 2024
Angiotensin receptor blockers (ARB) was associated with a decreased incidence of epilepsy compared with ACEIs (adjusted hazard ratio [aHR] = 0.75; 95% confidence interval [CI], 0.58-0.96), beta-blockers (aHR = 0.70; 95% CI, 0.54-0.90), and a combination of other antihypertensive classes (aHR = 0.72; 95% CI, 0.56-0.95). This held true even when patients with stroke were removed from the analysis, and was based on a 20 million patient database, avg age 61.7, between 2010 – 2017. The mechanism may be due to: ARBs suppressing the albumin-induced transforming growth factor β signaling cascade that blocks astrocyte activation and maintains the integrity of the blood brain barrier (BBB).
Lipoprotein (Lp) (a) is > 6-fold (point estimate of 6.6; 95% CI: 5.1-8.8) more atherogenic than that of LDL on a per-particle basis.
In patients with Lp(a) levels >50 mg/dL, aspirin had a 46% reduction in cardiovascular CV events compared with those not on aspirin (HR, 0.54; 95% CI, 0.32–0.94; P = .03). For the group that had Lp(a) levels <50 mg/dL, aspirin showed no benefit. Most insurance does not pay for Lp(a) testing, a cost of $21-$177.
A systematic review of 24 studies, 22,166 patients with prostate cancer, age 63-77 years, showed that androgen receptor signaling inhibitors increased the risk of hypertension (RR, 2.25; 95% CI, 1.74-2.90; P < .001), acute coronary syndrome (RR, 1.93; 95% CI, 1.43-1.60; P < .01), cardiac dysrhythmia (RR, 1.64; 95% CI, 1.23-2.17; P < .001), cerebrovascular events (RR, 1.86; 95% CI, 1.34-2.59; P < .001) and CV-related death (RR, 2.02; 95% CI, 1.32-3.10; P = .001), across the disease spectrum.
Among persons with moderate-to-severe obstructive sleep apnea and obesity, tirzepatide reduced the AHI, body weight, hypoxic burden, hsCRP concentration, and systolic blood pressure and improved sleep-related patient-reported outcomes in 459 patients, age 49.7, compared to placebo over 12 months.
Thank you, Joe for: a low dose of aspirin preemptively during periods of sleep deprivation mitigates inflammatory responses, decreasing: interleukin-6, the presence of COX-1/COX-2 double-positive cells in lipopolysaccharide-stimulated monocytes, and serum C-reactive protein in 46 healthy adults (19-63 years) in a randomized placebo-controlled crossover trial over a 14-day at-home phase followed by an 11-day in-hospital stay.
Tau PET predicted all-cause dementia (area under the receiver operating characteristic curve [AUC], 0.75; 95% CI, 0.70-0.80) better than a model including age, sex, education, and MMSE score (AUC, 0.71; 95% CI, 0.65-0.77; P = .02), and better than other neuroimaging markers.
In 167 frail older Spanish adults (≥70 years) randomized to routine invasive vs. conservative strategies after NSTEMI, showed no benefit in days alive out of the hospital during the first year.
Hospital readmission rates were not statistically different between telemedicine and in person transition of care management visits. The office readmission rate was 11.9% with 1,533 patients out of 12,846 compared to telemedicine readmission rate of 12.1% with 126 patients out of 1,045 patients.
Progressive walking and education intervention significantly reduced low back pain recurrence in 701 Australians, age 54, over 12-36 months (hazard ratio 0·72 [95% CI 0·60–0·85], p=0·000), and delayed recurrence from 112 to 208 days.
